Preventing heart disease: primary prevention. More and more people now get regular checks of their blood pressure, and tests to check for diabetes. Increasingly blood fat tests are done to check this risk factor too. All health professionals give lifestyle advice on stopping smoking, the benefits of exercise and the nature of a good diet. When specific risk factors are discovered, diet and lifestyle advice is given, but sometimes may not be followed for long. It is especially difficult to follow advice if the effect of not following it is likely not to matter for ten or more years, and if the changes needed are not attractive. The changes must be wanted by the individual who will be helped by encouragement from friends and relatives, and the changes must ideally be positive changes—’I want to do this’ not ‘They’ve told me to do this’. Any new dimension in heart disease prevention must be seen as a great positive change rather than as negative.

Treating heart disease and secondary prevention. When heart disease is detected two types of treatment are given. Firstly the effects of the disease are treated (e.g. medical treatment with drugs and surgical treatment to bypass blocked arteries) and, secondly, the risk factors are treated to slow down the further progression of the disease. Treatment of risk factors after the disease has already developed is ‘secondary prevention’. In people who have not yet developed the disease, treatment of risk factors is ‘primary prevention’. Obviously it would be better to give primary preventive treatment in all cases.

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